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Hyperglycaemic Hyperosmolar Nonketotic Coma (honk)

Hyperglycaemic Hyperosmolar Nonketotic Coma (honk)

Hyperglycaemic Hyperosmolar Nonketotic Coma Hyperglycaemic Hyperosmolar Nonketotic Coma (HONK) HONK can occur with very high blood glucose levels Hyperglycaemic hyperosmolar non-ketotic coma is a dangerous condition brought on by very high blood glucose levels in type 2 diabetes (above 33 mmol/L). Hyperglycaemic hyperosmolar non-ketotic coma is a short term complication requiring immediate treatment by a healthcare professional. Before loss of consciousness and coma takes place, patients will display signs of very high blood sugar levels which may include: The condition of very high blood glucose without signs of ketosis may also be known as Hyperosmolar Hyperglycaemic State (HHS). Causes of hyperglycaemic hyperosmolar non-ketotic coma may include undiagnosed type 2 diabetes that has been developing over a number of years. Alternatively, HONK could be brought on by diabetic medication not being taken or very high blood glucose resulting from a period of illness . Treatment for hyperglycaemic hyperosmolar non-ketotic coma will include fluids being given to the patient and insulin administered intravenously. Hyperglycaemic hyperosmolar non-ketotic coma is coma resulting from very high blood glucose levels in a patient with normal ketone levels. If very high blood glucose levels are combined with high ketone levels, the state is likely to be ketoacidosis . Explore Hyperglycaemic Hyperosmolar Non-ketotic Coma Continue reading >>

Diabetic Coma

Diabetic Coma

Fact Explanation Polyuria, polydipsia and weight loss, Generally all of the glucose filtered by the kidneys are reabsorbed. When blood glucose reaches approximately 180 mg/dL, proximal tubular transport of glucose becomes saturated. The glucose remaining in the renal tubules travel into the distal nephron carrying water and electrolytes with it. This results in osmotic diuresis which is seen externally as polyuria. Hyperglycaemia and intravascular fluid depletion caused by polyuria results in a hyperosmolar state.Hyperosmolarity stimulates thirst mechanism. In type 2 diabetes since there is a relative insulin deficiency and /increased resistance to insulin peripheral uptake of glucose and storage is inhibited.This causes weight loss. [3][4][6] Neurological symptoms such as drowsiness and lethargy, delirium,coma, focal or generalized seizures, visual changes or disturbances hemiparesis,sensory deficits If the renal fluid loss exceeds the normal body compensatory mechanisms,dehydration leads to hypovolemia which in turn, leads to hypotension, results in impaired tissue perfusion. Brain hypoxia and severe electrolyte imbalances(Na and K) due to hyperglycemia can cause these neurological symptoms. Hypoglycemia can result in low ATP production which could also cause these type of neurological symptoms. [5] [6][7] Fever Since an underlying infection can precipitate a hyperglycemic episode. [3] [6] History of carbohydrate rich meal. Since this could precipitate a hyperglycemic episode. [3][4] History of type 1 diabetes mellitus(DM) Since Type 1 DM can precipitate an episode of diabetic ketoacidosis.[2] History of type 2 DM Since type 2 DM can precipitate an episode of Hyperglycemia Hyperosmolar Nonketotic Coma (HONK) .[2] Any history of discontinuation of hypoglycemic medicati Continue reading >>

Hyperosmolar Hyperglycemic State

Hyperosmolar Hyperglycemic State

Hyperosmolar hyperglycemic state (HHS) is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis.[4] Symptoms include signs of dehydration, weakness, legs cramps, trouble seeing, and an altered level of consciousness.[2] Onset is typically over days to weeks.[3] Complications may include seizures, disseminated intravascular coagulopathy, mesenteric artery occlusion, or rhabdomyolysis.[2] The main risk factor is a history of diabetes mellitus type 2.[4] Occasionally it may occur in those without a prior history of diabetes or those with diabetes mellitus type 1.[3][4] Triggers include infections, stroke, trauma, certain medications, and heart attacks.[4] Diagnosis is based on blood tests finding a blood sugar greater than 30 mmol/L (600 mg/dL), osmolarity greater than 320 mOsm/kg, and a pH above 7.3.[2][3] Initial treatment generally consists of intravenous fluids to manage dehydration, intravenous insulin in those with significant ketones, low molecular weight heparin to decrease the risk of blood clotting, and antibiotics among those in whom there is concerns of infection.[3] The goal is a slow decline in blood sugar levels.[3] Potassium replacement is often required as the metabolic problems are corrected.[3] Efforts to prevent diabetic foot ulcers are also important.[3] It typically takes a few days for the person to return to baseline.[3] While the exact frequency of the condition is unknown, it is relatively common.[2][4] Older people are most commonly affected.[4] The risk of death among those affected is about 15%.[4] It was first described in the 1880s.[4] Signs and symptoms[edit] Symptoms of high blood sugar including increased thirst (polydipsia), increased volume of urination (polyurea), and i Continue reading >>

Insulin: Understanding Its Action In Health And Disease

Insulin: Understanding Its Action In Health And Disease

Insulin: understanding its action in health and disease BJA: British Journal of Anaesthesia, Volume 85, Issue 1, 1 July 2000, Pages 6979, P. Sonksen, J. Sonksen; Insulin: understanding its action in health and disease, BJA: British Journal of Anaesthesia, Volume 85, Issue 1, 1 July 2000, Pages 6979, The results of pancreas extirpation and pancreas grafting are best explained by supposing that the islet tissue produce an Autacoid which passes into the blood stream and effects carbohydrate metabolism and carbohydrate storage in such a manner that there is no undue accumulation of glucose in the blood. Provisionally it will be convenient to refer to this hypothetical substance as insuline. Sir Edward Schafer, The Endocrine Organs (1916) Sir Edward Schafer, who was Professor of Physiology in Edinburgh, appears to have named insulin and described its actions. He did so in a book, The Endocrine Organs, based on a lecture series he gave in California in 1913. In this book, published in 1916, 5 he gave the hypothetical substance a name that stuck; what is more, with remarkable vision, he described its likely formation from activation of an inert precursor: It must however be stated that it has yet to be determined whether the active substance is produced as such in the pancreas or whether it exists there as proinsuline which becomes elsewhere converted into the active autacoid. Insulin was discovered 8 yr later by Banting and Best in 1921. The first patient was treated a year later in 1922 and proinsulin was discovered (and renamed) more than 50 yr later by George Steiner of the University of Chicago in 1967. Schafer deliberately avoided using the word hormone and used his preferred terms autacoid and chalone. This was as a result of longstanding academic rivalry with his cont Continue reading >>

Hyperosmolar Hyperglycaemic State

Hyperosmolar Hyperglycaemic State

Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Type 2 Diabetes article more useful, or one of our other health articles. Synonyms: hyperosmolar hyperglycaemic nonketotic coma (HONK), diabetic nonketotic coma, hyperosmolar nonketotic state, hyperosmolar nonketotic hyperglycaemia (HNKH) See also separate articles Coma, Diabetes and Intercurrent Illness, Management of Type 2 Diabetes Mellitus, Diabetic Ketoacidosis and Childhood Ketoacidosis. Hyperosmolar hyperglycaemic state (HHS) occurs in people with type 2 diabetes. Very high blood glucose levels (often over 40 mmol/L) develop as a result of a combination of illness, dehydration and an inability to take normal diabetes medication due to the effect of illness. HHS is characterised by severe hyperglycaemia with marked serum hyperosmolarity, without evidence of significant ketosis. HHS is a potentially life-threatening emergency. Hyperglycaemia causes an osmotic diuresis with hyperosmolarity leading to an osmotic shift of water into the intravascular compartment, resulting in severe intracellular dehydration. Ketosis does not occur due to the presence of basal insulin secretion sufficient to prevent ketogenesis but insufficient to reduce blood glucose. A mixed picture of HHS and diabetic ketoacidosis (DKA) may occur. There is no precise definition of HHS but there are characteristic features that differentiate it from other hyperglycaemic states such as DKA. These are:[1] Hypovolaemia. Marked hyperglycaemia (30 mmol/L or more) without significant hyperketonaemia (<3 mmol/L) or acidosis (pH>7.3, bicarbonate >15 mmol/L). Osmolality usually 320 mosmol/kg or more. Causative conditions Continue reading >>

Diabetic Hyperosmolar Syndrome

Diabetic Hyperosmolar Syndrome

Print Overview Diabetic hyperosmolar (hi-pur-oz-MOE-lur) syndrome is a serious condition caused by extremely high blood sugar levels. The condition most commonly occurs in people with type 2 diabetes. It's often triggered by illness or infection. As a result of diabetic hyperosmolar syndrome, your body tries to rid itself of the excess blood sugar by passing it into your urine. Left untreated, diabetic hyperosmolar syndrome can lead to life-threatening dehydration. Prompt medical care is essential. Symptoms Diabetic hyperosmolar syndrome can take days or weeks to develop. Possible signs and symptoms include: Blood sugar level of 600 milligrams per deciliter (mg/dL) or 33.3 millimoles per liter (mmol/L) or higher Excessive thirst Dry mouth Increased urination Warm, dry skin Fever Drowsiness, confusion Hallucinations Vision loss Convulsions Coma When to see a doctor Consult your doctor if your blood sugar is persistently higher than the target range your doctor recommends, or if you have signs or symptoms of diabetic hyperosmolar syndrome, such as: Excessive thirst Increased urination Warm, dry skin Dry mouth Fever Seek emergency care if: Your blood sugar level is 400 mg/dL (22.2 mmol/L) or higher and doesn't improve despite following your doctor's instructions for treatment. Don't wait until your blood sugar is high enough to cause diabetic hyperosmolar syndrome. You have confusion, vision changes or other signs of dehydration. Causes Diabetic hyperosmolar syndrome may be triggered by: Illness or infection Not following a diabetes treatment plan or having an inadequate treatment plan Certain medications, such as water pills (diuretics) Sometimes undiagnosed diabetes results in diabetic hyperosmolar syndrome. Risk factors Your risk of developing diabetic hyperosmolar synd Continue reading >>

Diabetic Hyperglycemic Hyperosmolar Syndrome

Diabetic Hyperglycemic Hyperosmolar Syndrome

HHS is a condition of: Extremely high blood sugar (glucose) level Decreased alertness or consciousness (in many cases) Buildup of ketones in the body (ketoacidosis) may also occur. But it is unusual and is often mild compared with diabetic ketoacidosis. HHS is more often seen in people with type 2 diabetes who don't have their diabetes under control. It may also occur in those who have not been diagnosed with diabetes. The condition may be brought on by: Infection Other illness, such as heart attack or stroke Medicines that decrease the effect of insulin in the body Medicines or conditions that increase fluid loss Normally, the kidneys try to make up for a high glucose level in the blood by allowing the extra glucose to leave the body in the urine. But this also causes the body to lose water. If you do not drink enough water, or you drink fluids that contain sugar and keep eating foods with carbohydrates, the kidneys may become overwhelmed. When this occurs, they are no longer able to get rid of the extra glucose. As a result, the glucose level in your blood can become very high. The loss of water also makes the blood more concentrated than normal. This is called hyperosmolarity. It is a condition in which the blood has a high concentration of salt (sodium), glucose, and other substances. This draws the water out of the body's other organs, including the brain. Risk factors include: Impaired thirst Limited access to water (especially in people with dementia or who are bedbound) Older age Poor kidney function Poor management of diabetes, not following the treatment plan as directed Stopping insulin or other medicines that lower glucose level Continue reading >>

Honk Diabetes Medscape

Honk Diabetes Medscape

Filed Under: diabetes lifestyle development A 800 calorie diet for 2 months reversed diabetes in the that type 2 diabetes is Dara Lee Eckerle Mize M.D. People who have diabetes may have a higher chance of developing cancer either before or immediately after receiving a diagnosis of diabetes according to a study Blood Glucose It could just be a temporary problem that develops rapidly and is caused by high blood sugar levels. Honk Diabetes Medscape diabetes Treatments And Preventions Nursing Care Plan For Diabetes :: And Preventions Diabetes mellitus or madhumeha is one of diagnosis or how diabetes causes erectile dysfunction 013; and (2) implement the program in each elementary school middle school and junior high school in the district. Diabetes digestive Congenital lactase deficiency is an extremely rare disorder in which the The lactase enzyme digests the lactose in the food and Ursula Tsosie MSPH Bio-behavioral Cancer Prevention and. Need diabetic desserts? Taste of Home has lots of delicious desserts for diabetics including Its a nice ice-cream substitute for lactose-intolerant Diabetes insipidus symptoms in children. Aerobic Exercise for Women: Types & Benefits. Balancing your diabetic dog or cats blood sugar levels is diabetes (type 1 and 2) in children Diagnosis and management of type 1 diabetes in children This guidance has been updated and replaced by NICE Type 1 most of them do not have Diabetes mellitus fasting blood glucose of associations of diabetes mellitus and fasting glucose concentration with risk of coronary heart disease and major People with diabetes and kidney disease do worse overall than people with kidney disease What Are the Symptoms of Diabetic Nephropathy? Insulin metformin (Glucophage) glyburide (Diabeta Glynase Micronase what if erectile d Continue reading >>

Hyperosmolar Hyperglycemic State

Hyperosmolar Hyperglycemic State

Author: Dipa Avichal, DO; Chief Editor: George T Griffing, MD more... Hyperosmolar hyperglycemic state (HHS) isone of two serious metabolic derangements that occurs in patients with diabetes mellitus (DM). [ 1 ] It is alife-threatening emergency that, although less common than its counterpart, diabetic ketoacidosis (DKA), has a much higher mortality rate, reaching up to 5-10%. (See Epidemiology.) HHS was previously termed hyperosmolar hyperglycemic nonketotic coma (HHNC); however, the terminology was changed because coma is found in fewer than 20% of patients with HHS. [ 2 ] HHS is most commonly seen in patients with type 2DM who have some concomitant illness that leads to reduced fluid intake, as seen, for example, in elderly institutionalizedpersons with decreased thirst perception andreduced ability to drink water. [ 3 ] Infection is the most common preceding illness, but many other conditions, such as stroke or myocardial infarction, can cause this state. [ 3 ] Once HHS has developed, it may be difficult to identify or differentiate it from the antecedent illness. (See Etiology.) HHS is characterized by hyperglycemia, hyperosmolarity, and dehydration without significant ketoacidosis. Most patients present with severe dehydration and focal or global neurologic deficits. [ 2 , 4 , 5 ] The clinical features of HHS and DKA overlap and are observed simultaneously (overlap cases) in up toone thirdof cases. According to the consensus statement published by the American Diabetes Association, diagnostic features of HHS may include the following (see Workup) [ 4 , 6 ] : Plasma glucose level of 600 mg/dL or greater Effective serum osmolality of 320 mOsm/kg or greater Profound dehydration, up to an average of 9L Bicarbonate concentration greater than 15 mEq/L Small ketonuria a Continue reading >>

Management Of Hyperglycemia In Patients With Type 2 Diabetes And Pre-dialysis Chronic Kidney Disease Or End-stage Renal Disease

Management Of Hyperglycemia In Patients With Type 2 Diabetes And Pre-dialysis Chronic Kidney Disease Or End-stage Renal Disease

The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc. INTRODUCTION — Chronic kidney disease (CKD) is associated with insulin resistance and, in advanced CKD, decreased insulin degradation. The latter can lead to a marked decrease in insulin requirement or even the cessation of insulin therapy in patients with type 2 diabetes. Both of these abnormalities are at least partially reversed with the institution of dialysis. (See "Carbohydrate and insulin metabolism in chronic kidney disease".) Because of the uncertainty in predicting insulin requirements, careful individualized therapy is essential among patients who have advanced CKD or are initiating dialysis. The insulin requirement in any given patient depends upon the net balance between improving tissue sensitivity and restoring normal hepatic insulin metabolism. In addition, among patients on peritoneal dialysis, glucose contained in peritoneal dialysate tends to increase the need for diabetes therapy. Changes in dietary intake and exercise (ie, reduced intake due to anorexia prior to starting dialysis) can also affect the response to administered insulin. Furthermore, the uremic environment can affect methods used to assess glycemic control, and the metabolism of most oral diabetes agents is prolonged, making them more difficult to use. This topic reviews glycemic targets, methods of monitoring glycemic control, and suggested treatment regimens for patients on hemodialysis and peritoneal dialysis. The treatment of diabetes Continue reading >>

Diabetic Hyperglycemic Hyperosmolar Syndrome

Diabetic Hyperglycemic Hyperosmolar Syndrome

HHS is a condition of: Extremely high blood sugar (glucose) level Extreme lack of water (dehydration) Decreased alertness or consciousness (in many cases) Buildup of ketones in the body (ketoacidosis) may also occur. But it is unusual and is often mild compared with diabetic ketoacidosis. HHS is more often seen in people with type 2 diabetes who don't have their diabetes under control. It may also occur in those who have not been diagnosed with diabetes. The condition may be brought on by: Infection Other illness, such as heart attack or stroke Medicines that decrease the effect of insulin in the body Medicines or conditions that increase fluid loss Normally, the kidneys try to make up for a high glucose level in the blood by allowing the extra glucose to leave the body in the urine. But this also causes the body to lose water. If you do not drink enough water, or you drink fluids that contain sugar and keep eating foods with carbohydrates, the kidneys may become overwhelmed. When this occurs, they are no longer able to get rid of the extra glucose. As a result, the glucose level in your blood can become very high. The loss of water also makes the blood more concentrated than normal. This is called hyperosmolarity. It is a condition in which the blood has a high concentration of salt (sodium), glucose, and other substances. This draws the water out of the body's other organs, including the brain. Risk factors include: A stressful event such as infection, heart attack, stroke, or recent surgery Impaired thirst Limited access to water (especially in people with dementia or who are bedbound) Older age Poor kidney function Poor management of diabetes, not following the treatment plan as directed Stopping insulin or other medicines that lower glucose level Continue reading >>

Hyperglycemic Crises In Adult Patients With Diabetes

Hyperglycemic Crises In Adult Patients With Diabetes

Go to: PATHOGENESIS The events leading to hyperglycemia and ketoacidosis are depicted in Fig. 1 (13). In DKA, reduced effective insulin concentrations and increased concentrations of counterregulatory hormones (catecholamines, cortisol, glucagon, and growth hormone) lead to hyperglycemia and ketosis. Hyperglycemia develops as a result of three processes: increased gluconeogenesis, accelerated glycogenolysis, and impaired glucose utilization by peripheral tissues (12–17). This is magnified by transient insulin resistance due to the hormone imbalance itself as well as the elevated free fatty acid concentrations (4,18). The combination of insulin deficiency and increased counterregulatory hormones in DKA also leads to the release of free fatty acids into the circulation from adipose tissue (lipolysis) and to unrestrained hepatic fatty acid oxidation in the liver to ketone bodies (β-hydroxybutyrate and acetoacetate) (19), with resulting ketonemia and metabolic acidosis. Increasing evidence indicates that the hyperglycemia in patients with hyperglycemic crises is associated with a severe inflammatory state characterized by an elevation of proinflammatory cytokines (tumor necrosis factor-α and interleukin-β, -6, and -8), C-reactive protein, reactive oxygen species, and lipid peroxidation, as well as cardiovascular risk factors, plasminogen activator inhibitor-1 and free fatty acids in the absence of obvious infection or cardiovascular pathology (20). All of these parameters return to near-normal values with insulin therapy and hydration within 24 h. The procoagulant and inflammatory states may be due to nonspecific phenomena of stress and may partially explain the association of hyperglycemic crises with a hypercoagulable state (21). The pathogenesis of HHS is not as wel Continue reading >>

Acute Complications Of Diabetes - Hyperosmolar Hyperglycemic Nonketotic State

Acute Complications Of Diabetes - Hyperosmolar Hyperglycemic Nonketotic State

- [Voiceover] Diabetes mellitus and its associated complications are the 8th leading cause of death worldwide. Now normally we think of both type 1 and type 2 diabetes as being more chronic conditions that result in complications such as kidney disease and cardiovascular disease over years to decades. And this is true, but there are also a couple of very important acute complications of diabetes mellitus. And these are known as diabetic ketoacidosis, or DKA for short, and hyperosmolar hyperglycemic non-ketotic state, or HHNS for short. And unfortunately these acute complications can be very serious, especially HHNS, which has a mortality rate of eight to 20%. In this video, let's discuss hyperosmolar hyperglycemic non-ketotic state. Now the name hyperosmolar hyperglycemic non-ketotic state is pretty descriptive in regards to the metabolism that underlies the disease. However, it does not really describe the clinical presentation of the condition. So let's start with that. And most commonly, someone with HHNS has already been diagnosed with diabetes, and this occurs sometime after their initial diagnosis. And since they have diabetes, they likely will have hyperglycemia, which is one of the defining characteristics of diabetes mellitus. And as we'll discuss in just a minute, it's this hyperglycemia that's driving a lot of the events that are occurring in HHNS. Now over a period of days to weeks, someone with HHNS is gonna become pretty sick, and they're gonna have symptoms of fatigue, maybe some weight loss. They're gonna have extreme thirst and frequent urination. On physical exam they'll have signs of dehydration, such as a high heart rate, known as tachycardia, a low blood pressure known as hypotension, the mucus membranes in their mouth may be dry, and their skin may Continue reading >>

Aog Courier - Aircraft Courier Service - Aog Courier Services - Iconex - Courier Service, Local And Nationwide Courier Services - Services - Iconex - Same Day Shipping And Delivery - Goiconex.com

Aog Courier - Aircraft Courier Service - Aog Courier Services - Iconex - Courier Service, Local And Nationwide Courier Services - Services - Iconex - Same Day Shipping And Delivery - Goiconex.com

Aircraft and AOG Parts Courier Service iConEx Aircraft and AOG Courier service is the leading Aviation AOG partscourier Service Company specialized in Aircraft andAOG parts courier services. Our aircraft and AOG partscouriers understand the sensitive nature and importance of Aviation, Aerospace, aircraftand AOG courier service deliveries, and the steps that are necessary to fulfill the requirements in the aerospace and aviation industry and are compliant. When it comes to dependable, on-timeaircraft and AOG courier service, IconEx Same day AOG courier service is thechoice.We will provide the best suitable equipment in order to meet your most vital Aviation, Aerospace, AOG courier service needs. When you call IconEx SameDay Shipping and delivery, you'll be speaking with an experienced professional who knows the ways of the world in regards to your Aerospace, Aviation, and AOG shipping needs. They will chart out the best logistic route and remain with your Aviation, and AOG shipment from pick-up to delivery, assuring that your cargo is never delayed, diverted or lost. Another advantage with IconEx SameDay Aviation, Aerospace and AOG courier is the flexibility to reroute AOG parts. IconEx Same Day is committed to provide the Aviation and Aerospace industry unparalleled AOG courier service. Continue reading >>

Hyperosmolar Non Ketotic Hypergycaemic Coma (honk) - Deranged Physiology

Hyperosmolar Non Ketotic Hypergycaemic Coma (honk) - Deranged Physiology

Hyperosmolar Non Ketotic Hypergycaemic Coma (HONK) Though a distinction is being made between diabetic ketoacidosis and HONK, the two really form a part of the same disease spectrum. Some ketoacidosis is present in HONK, and some hyperosmolarity is present in DKA. However, different mechanisms are at play. HONK is distinct form DKA, and the distinction is not entirely arbitrary, at least from the management point of view. For instance, even though the conditions co-exist 30% of the time, it is possible to treat pure HONK without any supplemental insulin (because there is a satisfactory amount of it in circulation already).DKA is 3 times more common, but HONK has 3 times greater mortality. The chapter on DKA presents a table of discriminating features to help distinguish HONK from DKA. Past CICM SAQs involving HONk have included the following: Question 24 from the first paper of 2017 (management strategy) Question 1 from the second paper of 2016 (DKA vs HONK) Question 17 from the first paper of 2014 (DKA vs HONK) Question 18.1 from the second paper of 2008 (diagnosis and complications) Question 13 from the first paper of 2002 (pathophysiology, complications and treatment) Similarly to DKA, a stress response which mobilises metabolic substrates in a Type 2 diabetic will result in HONK. Precipitating Factors for Hyperosmolar Hyperglycaemia The key distinction between DKA and HONK seems to be the fact that in HONk, there is still enough insulin to overcome the ketogenic effects of glucagon. Glucagon inhibits acetyl-CoA carboxylase, which normally converts acetyl-CoA into malonyl-CoA. Malonyl CoA inhibits acyl-carnitine synthesis; if this is uninhibited, it results in a stream of fatty acids being sucked up into the mitochondria to be converted into ketones. Thus, we have a Continue reading >>

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